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The Association of Late-Life Depression, Cognitive Functioning, and Sleep Disorder in Aging

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The Association of Late-Life Depression, Cognitive Functioning, and Sleep Disorder in Aging The University of Maine DigitalCommons@UMaine Electronic Theses and Dissertations Fogler Library Summer 8-7-2019 The Association of Late-Life Depression, Cognitive Functioning, and Sleep Disorder in Aging Jessica B. Aronis University of Maine, [email protected] Follow this and additional works at: https://digitalcommons.library.umaine.edu/etd Part of the Developmental Neuroscience Commons Recommended Citation Aronis, Jessica B., "The Association of Late-Life Depression, Cognitive Functioning, and Sleep Disorder in Aging" (2019). Electronic Theses and Dissertations. 3115. https://digitalcommons.library.umaine.edu/etd/3115 This Open-Access Thesis is brought to you for free and open access by DigitalCommons@UMaine. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of DigitalCommons@UMaine. For more information, please contact [email protected]. THE ASSOCIATION OF LATE-LIFE DEPRESSION, COGNITIVE FUNCTIONING, AND SLEEP DISORDER IN AGING By Jessica Aronis B.A. Colby College, 2016 A THESIS Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Arts (in Psychology) The Graduate School University of Maine August 2019 Advisory Committee: Marie J. Hayes, Professor of Psychology, Advisor Ali Abedi, Professor of Electrical & Computer Engineering Fayeza Ahmed, Assistant Professor of Psychology Clifford Singer, Chief of Geriatric Mental Health and Neuropsychology Services © 2019 Jessica Aronis All Rights Reserved ii THE ASSOCIATION OF LATE-LIFE DEPRESSION, COGNITIVE FUNCTIONING, AND SLEEP DISORDER IN AGING By Jessica Aronis Thesis Advisor: Dr. Marie J. Hayes An Abstract of Thesis Presented In Partial Fulfillment of the Requirements for the Degree of Master of Arts (in Psychology) August 2019 The continuing growth in the demographic of aging individuals in the United States creates concern for diseases of aging that are chronic, notably unipolar depressive disorders. The high rates of depression in the aging population are a concern because of the strong association between late-life depression and cognitive impairment. Poor cognitive functioning is a hallmark of aging related neurological disorders, the most prevalent being Alzheimer’s Disease (AD). Sleep disorder is a core symptom of depression, and is definitively associated with the development of mild cognitive impairment (MCI), the prodrome of AD. MCI is also characterized by similar types of sleep disturbance including sleep fragmentation, which consists of excessive awakenings during the night that leads to atypical suppression of night-time full awakenings and chronic sleep debt that impairs daytime attention and cognition as a consequence of poor sleep quality. The main hypothesis of this study is that current or historical depression in older adults will be associated with poor sleep quality and cognitive impairment. Participants (N=50) from 65-85 years were assessed to determine the impact of depression status on sleep disturbance and cognitive variables. Individuals endorsing current depression (n=9), history of diagnosed depression but no current depression (n=7), or no current depression (n=34) were tested for 7 nights using wrist actigraphy and self-report sleep diaries to assess various sleep parameters used to identify sleep disturbance. Memory consolidation was probed surrounding one night of sleep using a simple procedural memory task and one-month follow-up assessment was used to assess a variety of neurocognitive domains including immediate and delayed recall, visuospatial abilities, etc. Results from this study revealed that individuals with current depression showed poorer sleep quality (i.e. shorter sleep time, lower mean sleep efficiency, longer sleep latency, etc.) and self-reported more sleep disturbances and greater daytime dysfunction when compared with individuals with no current depression or depressive history (p’s < .05). Results of impairment on cognitive tasks from participants with current depression or a history of diagnosed depression were not found. These results provide evidence of an association between sleep disturbance and late-life depression. Cognitive performance of depressed older adults warrants further exploration. TABLE OF CONTENTS LIST OF TABLES…………………………………………………………………………ix LIST OF FIGURES………………………………………………………………………...x LIST OF ABBREVIATIONS AND ACRONYMS……………………………………….xi CHAPTERS 1. INTRODUCTION………………………………………………………………………...1 1.1. Late-Life Depression and Cognitive Impairment are Strongly Associated…….5 1.1.1. Vascular Depression Hypothesis……………………………………...8 1.1.2. Amyloid Pathology…………………………………………………....9 1.1.3. Depression in MCI and AD…………………………………………...11 1.2. Cognitive and Brain Reserve…………………………………………………....13 1.2.1. Reserve assessed in research studies………………………………….15 1.2.2. The Reserve Threshold Hypothesis…………………………………...16 1.3. Sleep Disorder in Aging………………………………………………………...18 1.3.1. Cognition is Impaired by Sleep Deprivation………………………….19 1.3.2. Sleep Disorder as a Risk Factor and Symptom of Depression………...21 1.3.3. Sleep and Depression in MCI and AD………………………………...24 1.4. Hypotheses……………………………………………………………………....25 1.4.1. Hypothesis I: Impact of Age and Health………………………………25 1.4.1.1. Chronic Health is Associated with Depression Status……….25 1.4.1.2. Health Deterioration in Aging………………………………..25 iii 1.4.2. Hypothesis II: Depressive Symptoms are Connected to Poorer Sleep Quality…………………………………………………....26 1.4.2.1. Depressive Symptoms and Poor Objective Sleep Quality….26 1.4.2.2. Subjective Measures of Sleep will Reflect Objective Measures………………………………………………….26 1.4.2.3. Depressive History will Impact Sleep Quality………………..26 1.4.3. Hypothesis III: Current Depressive Symptoms Impair Cognition…....26 1.4.3.1. Historical Depressive Symptoms Impair Cognition………...27 1.4.4. Hypothesis IV: Higher Incidence of MCI in Depressed Older Adults………………………………………………………......27 1.4.5. Hypothesis V: Cognitive Reserve Moderates Levels of Cognitive Impairment…………………………………………………………….27 2. METHOD…………………………………………………………………………………28 2.1. Participants……………………………………………………………………………...28 2.1.1. Recruitment Sites…………………………………………………………......28 2.1.2. Inclusionary and Exclusionary Criteria……………………………………….29 2.1.3. Institutional Review Board Approval…………………………………….......30 2.1.4. Risks and Discomforts………………………………………………………..30 2.1.5. Benefits……………………………………………………………………….32 2.1.6. Confidentiality………………………………………………………………..32 2.1.7. Compensation………………………………………………………………...32 2.1.8. Voluntary Participation……………………………………………………....33 2.2. Materials and Measures………………………………………………………………...33 iv 2.2.1. Depression Measures………………………………………………………..34 2.2.1.1. Center for Epidemiological Studies Depression Scale…………....34 2.2.1.2. Supplemental Questions on Depressive History……………….....34 2.2.2. Neurocognitive Measures…………………………………………………...35 2.2.2.1. Montreal Cognitive Assessment………………………………......35 2.2.2.2. Overnight Procedural Memory Consolidation Task……………....35 2.2.2.3. Trail Making Test Part A and B…………………………………...38 2.2.2.4. Hopkins Verbal Learning Test-Revised…………………………...39 2.2.2.5. Boston Naming Test……………………………………………….39 2.2.2.6. Brief Visuospatial Memory Test Revised………………………....40 2.2.3. Cognitive Reserve Measures……………………………………………...…40 2.2.3.1. American National Adult Reading Test………………………...…41 2.2.3.2. Vocabulary subtest of the Wechsler Adult Intelligence Scale-Third Edition……………………………………………...…41 2.2.4. Sleep Measures……………………………………………………....41 2.2.4.1. SleepMove…………………………………………………42 2.2.4.2. Philips Respironics Actiwatch……………………………..42 2.2.4.3. Pittsburgh Sleep Quality Index…………………………….45 2.2.4.4. Stanford Sleepiness Scale………………………………….45 2.2.4.5. Consensus Sleep Diary………………………………….....45 2.2.4.6. Epworth Sleepiness Scale………………………………….46 2.3. Study Design and Procedure…………………………………………………...46 2.3.1. Participant Recruitment Protocol…………………………………….46 v 2.3.2. Sleep Study Visit…………………………………………………...47 2.3.2.1. Informed Consent………………………………………...48 2.3.2.2. MoCA Administration……………………………………48 2.3.2.3. Demographics…………………………………………….48 2.3.2.4. Depression Measures……………………………………..48 2.3.2.5. Sleep Measures…………………………………………...49 2.3.2.6. SleepMove Placement…………………………………….50 2.3.2.7. Overnight Memory Consolidation Task Training………...51 2.3.3. Neurocognitive Assessment Visit…………………………………...52 2.3.4. Scoring Protocol……………………………………………………..53 2.3.4.1. Philips Respironics Actiwatch Data Processing…………...54 2.3.4.2. Memory Consolidation Application Data Processing……..54 2.4. Data Analysis………………………………………………………………….54 2.4.1. Statistical Analysis……………………………………….….54 3. RESULTS……………………………………………………………………………….59 3.1. Demographic Characteristics………………………………………………………….59 3.1.1. Hypothesis I: Impact of Age and Health…………………………….63 3.1.1.1. Chronic Health is Associated with Depression Status…….63 3.1.1.2. Health Deterioration in Aging…………………………….63 3.2. Sleep Study……………………………………………………………………………64 3.2.1. Hypothesis II: Depressive Symptoms are Connected to Poorer Objective Sleep Quality……………………………………………..………64 3.2.1.1. Subjective Measures of Sleep will Reflect Objective Measures……………………………………......68 vi 3.2.1.2. Depressive History will Impact Sleep Quality…………...71 3.3. Neurocognitive Output Measures…………………………………………………….74 3.3.1. Hypothesis III: Current Depressive Symptoms Impair Cognition…………………………………………………....74 3.3.1.1. Historical Depressive Symptoms Impair Cognition……....77 3.4. MCI Diagnosis………………………………………………………………...78 3.4.1. Hypothesis IV: Higher Incidence of MCI in Depressed Older
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